Culture Affects How Hispanic Americans Experience Pain
Hispanic Americans tend to be more sensitive to pain than Whites. Yet Hispanic Americans report fewer pain conditions such as back pain and arthritis on surveys or questionnaires. These were only a few of the findings from a review article published this year in the Journal of Pain. National Institute on Minority Health and Health Disparities (NIMHD)–funded researchers from the School of Science at Indiana University–Purdue University Indianapolis (IUPUI) analyzed more than 100 studies on the pain experience of Hispanic Americans.
Though Hispanic Americans are the fastest growing ethnic group in the United States, much less is known about their pain experience—including potential disparities in pain treatment—than for other racial or ethnic minorities. "That's one factor that says, 'Wow, we should try to get an understanding of the pain situation for these folks,'" says Dr. Adam Hirsh, an assistant professor of psychology at IUPUI.
Laboratory research studies have shown that Hispanic Americans are more sensitive to pain than Whites. For example, compared with Whites, Hispanic Americans feel pain sooner when touching something hot or cold and tolerate the pain for shorter amounts of time.
So why do Hispanic Americans report fewer pain conditions on surveys? Surveys are more dependent on memory and context than studies conducted in the laboratory and might be more influenced by cultural factors. "Many Hispanic Americans have a strong cultural standard that reveres being strong in the face of adversity," says Hirsh. "So if I come from a culture that really values stoicism, I might be less likely to report or acknowledge my pain condition on a questionnaire."
Stoicism might help explain another discrepancy in the study. Hispanic Americans are more likely than other ethnic or racial groups to work in manual labor and blue-collar jobs, which puts them at greater risk for injury. Yet Hispanic Americans miss less work in the short term due to injury or pain than Whites.
Hirsh speculates Hispanic Americans may be more likely to try to push through their pain in the short term because their culture places a high value on work. "It may show up as low rates of disability in the short term, but it catches up with them in the long term." In the long term, Hispanic Americans have higher rates of disability: "Pain is such a primary cause of disability in our country. It was an interesting finding that I think really warrants a lot more attention going forward."
In addition to identifying several important trends, the analysis uncovered many gaps in our understanding of how Hispanic Americans experience pain. One such gap is the role of discrimination, says Hirsh: "Given the broader public discussion on immigration, we were somewhat surprised that there wasn't more about this." To begin to answer these questions, his research team is surveying how doctors make treatment decisions for Hispanic American patients who are in pain.
Much more is known about how doctors' biases contribute to disparities in treatment for African Americans. In an NIMHD-funded study, Hirsh and a graduate student, Nicole Hollingshead, are testing whether a computer-simulated intervention can change doctors' attitudes and lead to better treatment for African Americans. If successful, the intervention could be adapted to other racial or ethnic minorities, such as Hispanic Americans. But first, Hirsh says, researchers need to understand more about what causes disparities in pain treatment in African Americans.
"Hispanic Americans represent the largest proportion of Americans living in poverty and have the lowest rates of health insurance. Those things matter when talking about chronic conditions like pain," says Hirsh. "We're hoping that others will use this review to spur their own ideas and move this field forward."
- Hollingshead, N. A., Ashburn-Nardo, L., Stewart, J. C., Hirsh, A. T. (2016). The Pain Experience of Hispanic Americans: A Critical Literature Review and Conceptual Model. The Journal of Pain, 17(5), 513-528. doi: 10.1016/j.jpain.2015.10.022.